The Epidemiology Of Hiv Aids In La

THE EPIDEMIOLOGY OF HIV/AIDS IN LOS ANGELES The continued spread of HIV and all forms of hepatitis constitutes a public health crisis in America. The Center for Disease Control (CDC) points out that infections from syringe use go far beyond those who inject drugs. People who have sex with an injection drug user and children born to women exposed to these infections are also at risk. A 2003 CDC report documents that between 1981 (when AIDS first appeared) – 2001, approximately 1.4 million Americans contracted the virus that causes AIDS1. In the late 1990’s a new treatment became available known as antiretroviral therapy. As a result of introducing this new treatment, the number of persons who died from AIDS was substantially reduced. However, the need for prevention still existed as people were continuing to contract the virus itself. In fact, it is estimated that approximately 40,000 Americans have contracted AIDS each year since 1994. “Since the early 1990s, an estimated 40,000 new HIV infections have occurred annually in the United States. During 1999--2001, in the 25 states that had HIV reporting since 1994, the number of persons who had HIV infection newly diagnosed increased 14% among MSM and 10% among heterosexuals. The number of persons in the United States living with HIV continues to increase, and of an estimated 850,000--950,000 persons living with HIV, an estimated 180,000--280,000 (25%) persons are unaware of their serostatus”2. In January 2007, the Los Angeles Department of Public Health, published its semiannual surveillance summary on HIV/AIDS in LA County3. The number of persons reported as having contracted AIDS in LA was 694, the lowest number since documentation began. Men who are injection drug users and have male to male sexual 1

“Advancing HIV Prevention: New Strategies for a Changing Epidemic – United States, 2003”, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5215a1.htm 2 Flemi ng P, Byers RH, Sweeney PA, Daniels D, Karon JM, Janssen RS. HIV prevalence in the United States, 2000. [Abstract]. In: Program and abstracts of the 9th Conference on Retroviruses and Opportunistic Infections, Seattle, Washington, February 24--28, 2002. Alexandria, Virginia: Foundation for Retrovirology and Human Health. 3

http://lapublichealth.org/wwwfiles/ph/hae/hiv/Semiannual_Surveillance_Summary_January_ 2007.pdf

contact are the second highest group of those who contract HIV/AIDS, with persons who are injection drug users as the third highest group. Among women, those who are injection drug users are the second highest group of persons contracting HIV/AIDS. Injection drug use is reported as a risk factor in a substantial and steadily increasing proportion of Americans diagnosed with HIV and is largely responsible for heterosexual and perinatal transmission of HIV. Through 1985, 17% of AIDS cases reported to the Centers for Disease Control and Prevention (CDC) had been among IDUs4. According to research conducted in 2000 by Wohl, Johnson, Jordan, Lu, Beall, Currier, and. Kerndt5, African-American men have the highest rate of HIV/AIDS of any sub-group in LA County. While the highest rate is among men who have male to male sexual contact, the second highest rate is among men who are injection drug users. “Research on incarcerated persons in other locations suggests that IDU during incarceration is fairly common (9,10) and is associated with increased HIV risk (11,12). Sexual behaviors during incarceration, however, have not been widely documented (10–13) and have not been linked to increased HIV risk (11–13).”6 In a 2003 report7 prepared by the Mayor’s AIDS Leadership Council, HIV/AIDS has affected the LA area more heavily than the rest of the country, and the majority of people who contract HIV/AIDS continue to be persons of color. The report highlighted that one of the key variables continues to be the need for prevention strategies. Federal policies tend to focus on abstinence-related behaviors rather than condom and clean needle distribution. It outlines some of the issues which are specifically problematic in LA County: 1. A disproportionate number of men of African-American, Latino, Native American and Asian/Pacific Islander backgrounds contract HIV/AIDS 4

Centers for Disease Control. Update: Acquired immunodeficiency syndrome (AIDS)-United States. MMWR 1986;35:757,765. 5

“High Risk Behaviors During Incarceration Among African-American Men Treated for HIV at Three Los Angeles Public Medical Centers’, http://lapublichealth.org/wwwfiles/ph/hae/hiv/aamen1.pdf 6

Ibid HIV and AIDS in Los Angeles: 21st Century Approaches and Challenges”, http://www.lacity.org/DOD/indexpage/dodindexpage169423898_10062004.pdf 7

2. The importance of needle exchange programs in HIV/AIDS prevention has been acknowledged since the early 1990s 3. In 1994, the ACO assisted the Council and the Mayor’s Office in the issuance of a declaration of a local health emergency that directed City departments to take all steps permitted by law to ensure the availability and uninterrupted operation of needle exchange programs throughout the City. 4. LA County has the second highest number of AIDS cases in the country 5. The City of LA accounts for 56% of all AIDS cases in LA County 6. Male to male sexual contact (MSM) accounts for 72% of all AIDS cases in LA 7. Persons who are Transgendered have very few services targeted to their needs and a rough estimate states that 22% have HIV/AIDS – thus they are a community whose needs must be addressed

HIV/AIDS AND INCARCERATION RELATED ISSUES One of the primary concerns among professionals in harm reduction in LA, are the growing challenges related to HIV/AIDS and persons who are incarcerated in LA jails and prisons. According to a 2006 article8, “[…] the prevalence of HIV among US incarcerated populations is five to seven times that of the general US population… Furthermore, about 25% of people living with HIV in the US have been incarcerated. These statistics substantiate the need for ready access to HIV testing, treatment and prevention by means of behavioral interventions and harm reduction strategies in correctional facilities.”

THE EPIDEMIOLOGY OF HEPATITIS C IN LOS ANGELES As with HIV/AIDS, Hepatitis C is a critical health care issue in Los Angeles. There is a growing awareness of the public health crisis that Hepatitis C represents. Groups such as the LA County Task Force on Hepatitis C are driving this concern and determined to try and create workable strategies for the problem. Hepatitis C is also a blood-borne 8

“Challenges and opportunities for HIV care in Jails and prisons in the United States”, Anne S. De Groot, Madeline Dilorenzo, Mary Sylla & Joseph Bick, In International Journal of Prisoner Health, September 2006, 2(3), 173-191.

virus and as with HIV/AIDS, persons who are injection drug users are greatly at risk. Presently, they represent the highest group of people who are contracting the virus. Professionals who work in both the field of HIV/AIDS and Hepatitis C recognize the growing problem that Hepatitis C represents in LA. “Stephen Simon, AIDS coordinator for the city of Los Angeles, told health officials gathered for the Third Annual Los Angeles County Hepatitis C Summit on Thursday,as KPCC'sreports. Simon said one in 50 U.S. adults and as many as 650,000 California residents are infected with the virus, which is the leading cause of liver transplants in the U.S. According to a study published in 2000 in the American Journal of Public Health, if a more effective strategy is not adopted to fight hepatitis C, the virus could cause 193,000 deaths, $11 billion in health care costs and up to $54 billion in societal costs in the U.S. between 2010 and 2019, KPCC reports9.” Those people who are at greatest risk for contracting Hepatitis C are persons who are injection drug users, persons who live in poverty, veterans, and persons who are homeless. A factor which complicates this issue is that injection drug use is also highly connected to HIV/HEPATITIS C co-infection.

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Los Angeles County Health Officials Discuss Strategies for Fighting Hepatitis C at Third Annual Summit http://www.medicalnewstoday.com/articles/34086.php